Join SCN/Division 40 and be part of the APA 2015 Convention
Confirmed Invited Speakers
It's not too early to start planning for APA 2015! Whether you're a seasoned professional, early career psychologist, or trainee, the Society for Clinical Neuropsychology is designing programming with YOU in mind. Speakers already confirmed:
Donald Stuss, PhD, ABPP-CN
Ontario Brain Institute
Kathleen Welsh-Bohmer, PhD
Duke University School of Medicine
George Prigatano, PhD, ABPP-CN
Barrow Neurological Institute
Morris Moscovitch, PhD
University of Toronto
Angela Troyer, PhD
Baycrest Health Sciences
August 6-9, 2015 -- Toronto, ON
www.div40.org | www.facebook.com/division40
Blog of the Society for Clinical Neuropsychology, Division 40 of the American Psychological Association
Thursday, October 9, 2014
Society for Clinical Neuropsychology (APA Division 40) Early Career Award
The Society for Clinical
Neuropsychology (APA Division 40) is accepting applications for the Robert A. and Phyllis Levitt Early Career Award in
Neuropsychology. Eligible candidates are APA member psychologists not
more than ten years postdoctoral degree, who have made a distinguished
contribution to neuropsychology in research, scholarship, and/or clinical
work.
Application requirements: A letter of nomination and one
supporting letter (from a nationally-known neuropsychologist who is familiar
with the candidate’s work and its impact on the field) should be
included. The nominee should also send a (1) a CV, (2) three supporting
documents that provide evidence of national/international recognition (e.g.,
major publications, research grants, assessment, clinical, or teaching
techniques, treatment protocols), and (3) a 500-word
statement describing professional accomplishments, personal long-term goals,
and future challenges and directions in the field of neuropsychology that they
wish to address.
Application procedure: All materials provided by
applicant are to be submitted electronically to Michael Basso, Chair, SCN
Awards Committee, at michael-basso@utulsa.edu. Please submit all application
materials in a single .pdf file. The letter of nomination and supporting
letters may be included in the application file, or e-mailed directly to Dr.
Basso.
Application deadline: October 25, 2014
Award: The awardee will receive
$1,000 and may be invited to give an address at the 2015 APA Convention in
Toronto.
Apportionment Ballots
Neil Pliskin, PhD
President, Society for Clinical Neuropsychology
In a few weeks you will receive an apportionment ballot from APA. This is the method that determines division and state representation on APA’s Council of Representatives. You will be provided with 10 votes for allocation, and I strongly encourage you to allocate ALL of your votes for SCN/Division 40 (or at least 6/10) so that clinical neuropsychology can maintain its strong representation in the APA Council.
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| Neil Pliskin, PhD |
President, Society for Clinical Neuropsychology
In a few weeks you will receive an apportionment ballot from APA. This is the method that determines division and state representation on APA’s Council of Representatives. You will be provided with 10 votes for allocation, and I strongly encourage you to allocate ALL of your votes for SCN/Division 40 (or at least 6/10) so that clinical neuropsychology can maintain its strong representation in the APA Council.
Although
various issues confront our field as a whole, we know that reimbursement for
assessment and treatment services is one area that we can all agree demands
more attention from APA, along with other issues related to specialty practice. Apportionment of ballots is the way
that we get neuropsychology’s voice at the table. Representation by APA on national healthcare
issues is one of the biggest ways we have of influencing the process, and the
number of representatives to council we have is essential to effective
influence. Our council members have been
doing an excellent job representing our interests, but there is indeed strength
in numbers, and SCN is well-positioned to gain a better foothold within APA. I
strongly urge you to allocate your votes for SCN/Division 40 to maintain and
hopefully increase our representation within APA. Remember, every vote counts!
Nominations for Fellows
Nomination to become an APA Fellow
is an honor that recognizes evidence of unusual and outstanding contribution to
or performance in the field of psychology that has had impact beyond a
local, state, or regional level (i.e., national or international impact). Election
as a Fellow is an honor not only for the individual but for the Division as
well, and we welcome the nomination of outstanding division members for this
distinction who have made substantial contributions to the field of
neuropsychology.
Criteria: Evidence of unusual and outstanding contributions in the field of neuropsychology may be demonstrated in diverse ways reflecting the diversity of career and practice roles performed by neuropsychologists. Supporting letters and the candidate’s self-statement should clearly and specifically identify the candidates’ unusual and outstanding qualifications that have advanced the field, and should not be summary statements about the candidate’s general competency. Examples of contributions in Clinical Neuropsychology of interest to the Committee include, but are not limited to, the following:
Nominations of Initial Fellows: The nomination procedure for an SCN member applying for Fellowship is outlined on the division website listed at the end of this notice. Application requires the completion of a "Uniform Fellow Blank," which is available on the SCN website. A minimum of three endorsement letters are required, preferably from current APA Fellows who can address the nominee’s accomplishments in the area of neuropsychology. Other requisite supporting materials include a current vita, a listing of the nominee's publications with "R" for refereed indicated, and the nominee's self-statement setting forth the accomplishments that warrant Fellow status in SCN. SCN strongly encourages women and minority members to apply for Fellowship.
Submission of Materials: All nomination materials should be completed and submitted to the Division's Fellowship Committee Chair listed below (not APA Central Office) by December 1, preferably as electronic pdf or Word files. Those nominees supported by the SCN Fellows Committee will be forwarded to the APA Fellows Committee for consideration. Successful nominations are announced in August the following year after the APA annual meeting. Nomination materials can be obtained from the APA website listed below.
APA Fellow Forms url: http://www.apa.org/membership/fellows/index.aspx
The University of Toledo
2801 W. Bancroft Street
Toledo, OH 43606-3390
Email: john.mcsweeny@utoledo.edu
Criteria: Evidence of unusual and outstanding contributions in the field of neuropsychology may be demonstrated in diverse ways reflecting the diversity of career and practice roles performed by neuropsychologists. Supporting letters and the candidate’s self-statement should clearly and specifically identify the candidates’ unusual and outstanding qualifications that have advanced the field, and should not be summary statements about the candidate’s general competency. Examples of contributions in Clinical Neuropsychology of interest to the Committee include, but are not limited to, the following:
- Supporting specialty recognition through board certification in Neuropsychology (e.g., ABPP/ABCN)
- A record of scientific and/or clinical accomplishments published in respected peer reviewed journals
- Authorship or editorship of a major psychology textbook(s)
- Federal grant support
- Senior level lectureships/invited presentations
- Journal editorial or reviewer responsibilities
- Elected and volunteer positions in professional or academic organizations
- Evidence of outstanding teaching and/or innovation in clinical neuropsychology
- History of mentorship of students and early career colleagues
- Development of innovative therapeutic applications
- Other evidence of outstanding contributions that have a national or international impact
Nominations of Initial Fellows: The nomination procedure for an SCN member applying for Fellowship is outlined on the division website listed at the end of this notice. Application requires the completion of a "Uniform Fellow Blank," which is available on the SCN website. A minimum of three endorsement letters are required, preferably from current APA Fellows who can address the nominee’s accomplishments in the area of neuropsychology. Other requisite supporting materials include a current vita, a listing of the nominee's publications with "R" for refereed indicated, and the nominee's self-statement setting forth the accomplishments that warrant Fellow status in SCN. SCN strongly encourages women and minority members to apply for Fellowship.
Nominations of Current Fellows: APA
Members who are already Fellows in other Divisions may also become Fellows in SCN/Division
40. The same nomination materials as are required for initial fellow
appointments must be submitted. Nominees should demonstrate their specific
accomplishments in the area of neuropsychology.
Submission of Materials: All nomination materials should be completed and submitted to the Division's Fellowship Committee Chair listed below (not APA Central Office) by December 1, preferably as electronic pdf or Word files. Those nominees supported by the SCN Fellows Committee will be forwarded to the APA Fellows Committee for consideration. Successful nominations are announced in August the following year after the APA annual meeting. Nomination materials can be obtained from the APA website listed below.
APA Fellow Forms url: http://www.apa.org/membership/fellows/index.aspx
A John McSweeny, JD, PhD
Department of Psychology MS#948The University of Toledo
2801 W. Bancroft Street
Toledo, OH 43606-3390
Email: john.mcsweeny@utoledo.edu
From the President's Corner
Neil Pliskin, PhD
President, Society for Clinical Neuropsychology
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| Neil Pliskin, PhD |
President, Society for Clinical Neuropsychology
As
everyone knows or has experienced by now, healthcare delivery in the United
States is undergoing a major transformation. The passing of the
Affordable Care Act has led to the formation of Accountable Care Organizations
(ACOs) in many states. One of the main ways the Affordable Care Act seeks
to reduce health care costs is by encouraging doctors, hospitals and other
health care providers to form networks which coordinate patient care and become
eligible for bonuses when they deliver that care more efficiently.
This
emphasis on coordinated or INTEGRATED CARE is already occurring in many medical
centers, and it is changing the way that medicine (and neuropsychology) is
being practiced. While many of us “seasoned veterans”
(#neuropsychologydinosaurs) are still working in our comfortable
“silos” of clinical practice, it is highly likely that more of us
will be practicing differently in a few years, and certainly the upcoming
generation of neuropsychologists needs to understand and be prepared for
changes in neuropsychology practice models. Indeed, neuropsychologists
working in institutions, medical centers and VAs will be increasingly “embedded”
in multispecialty clinics with approaches to assessment shifting to shorter
batteries, shorter reports and fast feedback. The shifts in practice
models is already occurring in some settings, with neuropsychologists working
in primary care clinics, and specialty clinics (memory, geriatrics, pediatrics,
diabetes, epilepsy) to name a few.
The most recent membership data about our Division indicate that we have 4754 members, of which 80% are licensed, 70% provide clinical services and 43% are in independent practice, so this topic is highly relevant to a majority of our Division members. Therefore, I would like to learn more from members who are already involved in providing neuropsychology services in the context of integrated settings, and I would like to share this information over the course of the year with our early career psychologists and students who will be facing these challenges in their future.
Within the next several months, you will receive a survey inquiring about your experience with different models of integrated care in neuropsychology. Please take the time to respond to the survey and share with our membership your experiences, and I will be sure to include updated information in the coming months through our blogs, newsletters and NeuroBlasts. Additionally, a portion of SCN’s program at the upcoming 2015 APA convention in Toronto (August 6-9) will be devoted to presentations on Models of Integrated Care in Neuropsychology. Please save the date and plan on attending the convention.
SCN colleagues, the era of integrated care creates new opportunities for providing services and for demonstrating our value in the world of healthcare. If you have comments, thoughts, suggestions or experiences you wish to share, I would welcome hearing from you during this year; please feel free to contact me (npliskin@uic.edu).
The most recent membership data about our Division indicate that we have 4754 members, of which 80% are licensed, 70% provide clinical services and 43% are in independent practice, so this topic is highly relevant to a majority of our Division members. Therefore, I would like to learn more from members who are already involved in providing neuropsychology services in the context of integrated settings, and I would like to share this information over the course of the year with our early career psychologists and students who will be facing these challenges in their future.
Within the next several months, you will receive a survey inquiring about your experience with different models of integrated care in neuropsychology. Please take the time to respond to the survey and share with our membership your experiences, and I will be sure to include updated information in the coming months through our blogs, newsletters and NeuroBlasts. Additionally, a portion of SCN’s program at the upcoming 2015 APA convention in Toronto (August 6-9) will be devoted to presentations on Models of Integrated Care in Neuropsychology. Please save the date and plan on attending the convention.
SCN colleagues, the era of integrated care creates new opportunities for providing services and for demonstrating our value in the world of healthcare. If you have comments, thoughts, suggestions or experiences you wish to share, I would welcome hearing from you during this year; please feel free to contact me (npliskin@uic.edu).
Friday, May 16, 2014
NeuroBlog: The Value of Student Involvement in Neuropsychology Governance
Cady
Block, ANST Chair
When I was first asked to write a
piece for our NeuroBlog, I immediately knew I wanted to write about a topic
that I am very passionate about: student involvement in neuropsychology
governance. My own journey into student governance has been a very rewarding
one. When I began my doctoral work at UAB in 2008, another student and myself
saw the need for representation of student interests in neuropsychology within
our program. With some research and a little bit of luck, we found out that APA
has a Division representing neuropsychology, and that this Division not only
has a trainee organization (the Association of Neuropsychology Students in
Training, or ANST) but that it sponsors a network of chapters. We began our own
UAB chapter and it is still successful and thriving today.
I
then became interested in issues impacting all trainees and wanted to become
more involved in governance at the national level. I was elected as the
national ANST Communications Officer, which was followed by being elected the
national Chair for ANST. I find that both of these positions offered the
opportunity to connect and network with other individuals who are passionate
about improving the profession for current and our future colleagues, and to
effect change at the national level. Student leadership has been a valuable
experience for me, and I hope to share my excitement and passion with other
trainees and create opportunities for others to become more involved. I know
such an experience can seem very daunting to trainees, but I would encourage
them by saying that becoming involved is actually easier than one might think
and the rewards in return are countless! The Society for Clinical
Neuropsychology and ANST have long fostered such an opportunity through our
network of chapters housed at various doctoral programs throughout the country.
Chapters are led by active, energetic trainees and offer an excellent entry
into student leadership and can often open the door for later involvement to
neuropsychology governance. In fact, one of our original two student founders
of ANST – Michael Cole – is currently the head of the SCN Publications and
Communications Committee! Our current SCN Communications Liaison and former
ANST Chair, Erica Kalkut, also began as a chapter representative at her
doctoral program.
I
could continue on about the many, many benefits of becoming involved in student
leadership and neuropsychology governance. However, I felt that the best people
to speak to this are some of our wonderful chapter representatives. I offer my
thanks and appreciation to each of them for their willingness to contribute to
this NeuroBlog piece. I also offer my gratitude to the excellent people in SCN
who make these experiences available to trainees. I hope you enjoy this piece!
Jesse Passler, University
of Alabama at Birmingham
It was very important to me to
become involved with the ANST chapter at University of Alabama at Birmingham
(UAB) as soon as possible. The importance of being a part of ANST leadership to
me cannot be overstated. It has proven to be an excellent way to become
integrated into the neuropsychology community at UAB as well as across the
country. I have also found the support and knowledge of fellow ANST chapters
(as well as ANST’s wonderful leadership!) to be such an appreciated resource in
my professional development.
However,
the most important experience I’ve garnered from the opportunity to serve in
student governance is that of being continually humbled by the amazing people
around me. I have always had aspirations to serve as a leader, both
professionally and in the community. Stated simply, serving in a leadership
role requires honesty, openness, and the challenge to adequately represent a
group as a whole as opposed to any special or specific expertise. In this way,
I have been honored to work alongside my fellow UAB ANST members in trying to
ensure both an excellent professional and personal experience. I highly
encourage this opportunity to other students; I hope that you’ll find, as I
have, that better than growing personally or (in some small way) helping others
to grow, is growing together.
Dede
Ukueberuwa, Pennsylvania State University
Once interested in gaining
leadership experience, many students may feel uncertain about how to get
started. Talking to an advisor or another faculty member in their program is a
great first step. An advisor may be involved in professional organizations or
know about committees that welcome student members. Talking to an advisor may
also help students to assess their strengths and to build confidence in their
ability to be a leader. Through the process of searching for opportunities,
students learn about the work of different organizations, which then helps to
further define their own interests – are they drawn to public education about
clinical neuropsychology, advocating for legislature that promotes our mission,
or reviewing research projects for publication or awards? Once students start
to get involved, they will likely feel more comfortable sharing their skills
and ideas, develop a sense of identity as a clinical neuropsychologist in
training, and continue growth as a leader in the field.
Nick Bott, Palo
Alto University
Woody
Allen has opined that 80% of success is showing up, and this resonates with my
experience in becoming involved in leadership and governance of my program's
ANST chapter. The current ANST leadership was transitioning out, and in
speaking with one of the chapter reps at the end of a meeting, she asked me
about ideas for how to strengthen the resources and opportunities that the
chapter offers to students. Sharing some of my ideas turned into a conversation
about becoming more involved in leadership and eventually led to my taking a
leadership role as the ANST co-chapter rep for our program.
Having served as co-chapter rep for
two years now, I am so happy that I showed up. My time helping to lead our
chapter has convinced me of the importance of leadership and governance as an
integral part of graduate school education. Graduate work encompasses three
spheres: clinical education, research, and involvement in the field of the
profession. Often, one or two of these becomes the focus of a graduate student,
to the exclusion of the other. And sadly, it is often involvement in the field
that is first to go. But involvement in the field is incredibly important.
Knowledge of the structures that govern and support the field, and the networks
of professionals that provide leadership for these structures is an education
in itself, and extremely valuable for your own professional development in the
expansion of your professional network and your understanding of the issues
that are facing our field. And the field shrinks incredibly once you start
engaging in a professional leadership capacity. You also realize that the
volunteerism of students and professionals is critical to supporting so many
budding neuropsychologists, as well as supporting the profession as a whole.
Without serving in a leadership capacity, you are much less likely to be
exposed to this critical area within our field. So my recommendation: show up
and see what happens!
Tuesday, January 28, 2014
Clinical Neuropsychology and Sports Concussion: Have We Come Full Circle?
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| William B. Barr, PhD, ABPP |
Associate Professor of Neurology & Psychiatry,
NYU School of Medicine
This
year marks the 20th anniversary of the “modern era” in the study of concussion
in sports, which began in 1994 following the retirements of Merrill Hoge and Al
Toon and the National Football League’s (NFL) formation of its first Mild
Traumatic Brain Injury Committee. Since that time, we have witnessed a marked
shift from what was a pervasive attitude of denying or minimizing the effects
of head injury in sport to one where stories of the current “concussion
epidemic” or the controversy about long-term consequences of head injury in
retired athletes appear in our newspapers on a daily basis. Over the same time
period, the field of neuropsychology has received an unprecedented degree of public
attention resulting from the fact that many in our field, including members of
the Society of Clinical Neuropsychology (SCN), have provided important
contributions to the scientific study of sports concussion and development of
methods for its assessment. My goal in this SCN
NeuroBlog is to provide a brief review and critique of neuropsychology’s
role in the clinical management of sports concussion with suggestions on how we
can maintain our position as leaders with regard to this highly publicized
injury.
At
the beginning of concussion’s modern era, it was not uncommon to hear
statements from other health professionals that we were in the infancy in the
study of the head injury and without any available scientific information to
guide clinical management. Any practicing neuropsychologist at that time knew
that this was not the case. We were well aware that Dorothy Gronwall and her
colleagues in New Zealand had published a number of groundbreaking studies during
the 1970’s, using neuropsychological methods for tracking information-processing
capacity following minor head injury. During
the 1980’s, Jeffrey Barth,
Sureyya Dikmen, and Harvey Levin and colleagues
had all conducted a number of important investigations in the United States using
neuropsychological test batteries to characterize outcomes in mild head injured
subjects. The results of those studies demonstrated that recovery from milder
forms of head injury was characterized by a complex interaction of cognitive,
somatic, and emotional factors with the expression of symptoms influenced
significantly by a range of psychosocial factors.
Armed
with the findings from studies listed above, clinical neuropsychologists were
well prepared in the 1980’s and 1990’s to conduct a comprehensive assessment of
symptoms in patients they encountered following what was eventually termed as
mild traumatic brain injury (MTBI). Many at that time continued to use the Halstead-Reitan
Neuropsychological Test Battery for evaluation of these patients. However, an
increasing number of practitioners began to use a more flexible approach to neuropsychological
assessment, with test batteries comprised of measures of intelligence,
attention, executive functions, and memory. It is important to note that, most
clinicians were also including measures of symptom reporting in their test
batteries, using standardized measures such as the Minnesota Multiphasic
Personality Inventory (MMPI) and its descendants. While the clinical batteries often took
numerous (3-6) hours to complete, they provided the most effective means known
at that time for evaluating symptoms in patients with MTBI.
Neuropsychology’s
approach to head injury received a substantial boost in the late 1980’s following
research performed by Barth, Macciocchi and colleagues at the University of
Virginia, who developed the methodology for obtaining empirical data on
concussion through controlled prospective studies of athletes following head
injury. Their model of data collection, now known as the Sports Laboratory
Assessment Model (SLAM) consisted of obtaining preseason neuropsychological test
data to serve as a baseline in athletes at risk for sustaining a concussion
during competition and repeating the same tests in injured athletes and matched
controls on a serial basis to measure the effects of the injury and its pattern
of recovery. Among the major findings from early studies using the SLAM
methodology were that neuropsychological tests were established as being
sensitive to the effects of concussion and that those effects were observed to
clear rather rapidly, within a period of 5 to 10 days, in the vast majority of
cases.
Given
the fact that results from standard imaging and electrophysiological studies
were usually negative in athletes following concussion, the hope in the
beginning of the modern era of sports concussion management was that
neuropsychological testing would provide most effective means for assessing
symptoms during recovery. The SLAM methodology was promptly adapted for
clinical use by a number of neuropsychologists working primarily with
collegiate and professional football teams. Brief test batteries were assembled
and administered to entire teams through large-scale baseline testing programs.
The length of the test batteries was kept to less than 30 minutes,
understanding the need to limit the time burden for the athletes and the
assessment team. The test batteries were limited in contents to measures of
attention, processing speed, and memory, while also including a brief measure of
post-concussion symptoms. The belief was that, due to athletes’ reputed
tendency to minimize symptoms, information from the neurocognitive tests administered
serially following injury would provide the most accurate means for tracking
the effects of the injury and marking the time course of its recovery.
The
baseline testing programs in sports began with the use of paper-pencil tests
that were readily available to all licensed neuropsychologists. However, those
tests were soon replaced by computerized test batteries developed specifically
for assessment of concussion symptoms in athletes, which were promoted and sold
via a large-scale marketing campaign to physicians, certified athletic
trainers, and other clinicians in addition to neuropsychologists. The
computerized tests were claimed by their developers to provide an advantage
over the paper-pencil tests by providing a more sensitive, reliable, and
efficient means of assessing concussion symptoms. Through substantial media
exposure, the brand names of computerized tests became synonymous with baseline
testing in sports, with the science and methodology of clinical neuropsychology
relegated to a less prominent role.
While
sportscasters, the media, and the public at large were emphasizing the use of baseline
testing in sports, there was a controversy developing within the field of
neuropsychology regarding its ultimate benefits. Some investigators began to
question the increasing use of this methodology, given the lack of empirical support,
particularly from investigative teams that were independent of the test
developers. This was followed by studies, emerging over time, demonstrating
that information from neuropsychological tests added little to the
assessment of acute post-concussion symptoms compared to what was obtained
through a more brief form of sideline testing using a combination of symptom
questionnaires, balance measures, and a brief screen of cognitive functioning.
Results
from other investigations began to show that many of the tests used for serial
testing in athletes demonstrated unacceptably low levels oftest-retest reliability in addition to disappointing levels of sensitivity/specificity
for detecting the effects of concussion. The validity of the baseline test
performance came into question when measures were administered on a group basis, as
suggested by the manufacturers. Athletes began to realize the benefits of underperforming
on baseline testing so that the effects of concussion would be obscured on
repeat testing following injury, affecting the validity of a growing number of
baseline assessments. Further complications began to emerge from the fact that practitioners
without adequate training in psychometrics and brain-behavior relations were
often the ones obtaining the test results following injury, causing them in
many cases to make serious interpretive errors. Based on these findings and
trends, an international panel of experts on concussion in sports concluded in
statements published in
2012 that, “there is insufficient evidence to recommend the widespread
routine use of baseline neuropsychological testing.”
Turning
to what we have learned over the past 20 years, there has been a convergence of
information obtained through studies of animal models and humans indicating
that the acute physiological effects and symptoms associated with concussion
resolve within 7-10 days
in the vast majority (80%-95%) of injured athletes, upholding the findings
originally reported much earlier by University of Virginia group. While
cognitive deficits are known to be present during the acute time period, neuropsychological
testing does not appear to be the optimal choice for assessment at that time, since
symptoms can be monitored effectively through briefer sideline test procedures using
the Sports Concussion Assessment Tool (SCAT-3).
However,
as most neuropsychologists know, there are those individuals, including
athletes, who continue to report symptoms well beyond the window of typical
recovery from concussion. These individuals, exhibiting symptoms of what we
term as post-concussion syndrome (PCS), create clinical conundrums for most
clinicians involved in concussion management. I argue that this is the group on
whom neuropsychologists should be focusing attention. As a result of neuropsychologists’ unique
combination of training and use of empirically advanced assessment techniques, we
are the group of professionals who can provide the most valuable input for diagnosis
and management for of individuals with PCS.
Investigators
focusing on the search for the elusive biomarker of concussion often ignore the
fact that the diagnosis of concussion and subsequent PCS is based primarily on
a subject’s subjective account of his or her symptoms. We are well aware that the
reporting of those symptoms can be affected substantially by a number of
“non-injury” factors. To begin with, research has shown that those with PCS
commonly experience co-morbid conditions such as mood disorder, chronic pain, attention
deficit hyperactivity disorder (ADHD), or the effects of somatization, all of
which can result symptoms overlapping with those commonly reported in PCS. We
are also aware that a number of “normal” psychological factors secondary to
misattribution of symptoms, including “expectation
as etiology”, the “diagnosis
threat”, and the “good
old days” phenomenon can influence symptom expression in that group. We are
likely to be seeing an increase in the frequency of these misattribution phenomena
as a result of increased availability of information related to concussion
available through the popular media and Internet. Using our strengths in clinical
assessment, neuropsychologists are in an excellent position to serve as those
members of the treatment team who are in the best position to identify and
treat the co-morbid conditions and other important “non-injury” factors that
can influence the reporting of PCS symptoms in athletes and other groups.
My
belief is that the optimal time for a referral to clinical neuropsychologists
in a sports concussion setting is not immediately following the injury, but
when the athlete is continuing to report symptoms for a period of 14-days or
more. At that relatively early time point, he or she will have passed through
the typical period of symptom recovery but will have not yet reached the
critical juncture when PCS symptoms have become chronic and possibly
intractable in nature. A comprehensive neuropsychological evaluation using
tests of cognitive functioning, self-report, and performance validity performed
at that time will provide the clinician with valuable diagnostic data and
information to guide recommendations for subsequent intervention. As
demonstrated in clinical studies, early
identification and treatment of the co-morbid conditions and psychological
factors provides the most effective means known for preventing the development
of long-term PCS symptoms.
In conclusion,
while we can admire our field’s initial attempt to offer neuropsychological
testing as the primary tool for tracking the acute symptoms of concussion in
athletes, it is time to admit that these watered-down test batteries did not
end up being as useful as we had hoped.
My opinion is that clinical neuropsychologists can now play a more
important and useful role in the management of sports concussion by going back
to where we were 20 years ago by providing evaluations of athletes using more
comprehensive test batteries prior to development of chronic PCS symptoms. I am
not suggesting that we return to the use of 3-6 hour test batteries with all of
these athletes. We can clearly benefit from advances in test development and
clinical studies of concussion to narrow our test batteries down to less than
two hours, including the use of a comprehensive symptom measure such as the
MMPI-2-RF. In the end, returning to the
“psychology” in neuropsychology will enable us to provide a unique
perspective to the modern treatment team that has evolved for assessment and
treatment of sports concussion and help many of our athletes obtain the
services they need to reach a full and successful recovery.
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